title: The safety and efficacy of midlines compared to peripherally inserted central catheters for adult cystic fibrosis patients: a retrospective, observational study.
abstract: BACKGROUND
  Intravenous antibiotics are the cornerstone of treatment for patients with cystic fibrosis (CF). Midlines are a type of vascular access device (VAD) used exclusively in one treatment facility within Australia, most other centres use peripherally inserted central catheters (PICCs).
  
  
  OBJECTIVE
  To ascertain the safety and efficacy of midlines for CF patients receiving intravenous antibiotics.
  
  
  METHODS
  Retrospective observational.
  
  
  METHODS
  A large, major metropolitan teaching hospital in Adelaide, South Australia.
  
  
  METHODS
  Adult patients with a diagnosis of CF, who had a PICC or midline inserted for the commencement of antibiotic therapy during the period 2004-2010 to treat a respiratory exacerbation.
  
  
  METHODS
  Medical records and hospital reports were used to record rates of adverse events and unexpected removal of VADs. The primary outcome was a composite measure of adverse events (catheter-related blood stream infection, deep vein thrombosis, occlusion, pain, infiltration, bleeding, phlebitis, catheter leakage and dislodgement) and whether the VAD was removed unexpectedly.
  
  
  RESULTS
  There were 231 midlines and 97 PICCs inserted into 64 patients (39 male and 25 female; age range 18-47 years old). Presented as per 1000 VAD days, patients with PICCs and midlines had similar rates of adverse events (14 and 11 adverse events per 1000 VAD days, respectively). Unexpected removal was higher for patients with midlines (6.90 per 1000 VAD days) than for PICCs (2.89 per 1000 VAD days). Incident rate ratios (IRRs) showed that patients with midlines and PICCs had similar rates of adverse events (IRR 1.18, P=0.617, CI 0.62-2.22) although the removal rate of patients with midlines was twice that of patients with PICCs (IRR 2.24, P=0.079, CI 0.91-5.56). As an absolute risk there were only 4.09 more cases of removal for patients with midlines per 1000 VAD days than those with PICCs.
  
  
  CONCLUSIONS
  Midlines may be an alternative to PICCs for adult CF patients although further research is required with a larger sample size to enable definitive conclusions.
authors.affiliation: School of Nursing and Midwifery, University of South Australia, Adelaide, Australia. Electronic address: rebecca.sharp@mymail.unisa.edu.au.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sharp
authors.affiliation: School of Nursing and Midwifery, University of South Australia, Adelaide, Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Esterman
authors.affiliation: Florence Nightingale School of Nursing & Midwifery, King's College London, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: McCutcheon
authors.affiliation: Department of Radiology, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Neville
authors.initials: N
authors.lastname: Hearse
authors.affiliation: Department of Radiology, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Melita
authors.initials: M
authors.lastname: Cummings
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D003550:Cystic Fibrosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013021:South Australia; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Catheterisation-adverse effects; Catheters vascular; Cystic fibrosis; Midlines; Observational; Peripherally inserted central catheters